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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
di.� of Bedrooms c Date 9
This permit is granted to �< < �� foz� tie Installation �1of aseptic tank-.
,it the residence of�Z c e Address G c. it
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. S>ci2 ,
Manufacturer's Name 4L Address
No. of lines _width 36 n. Total Length o o ft. No. of Sq. Ft. OP
Type of filter material� Total tons used
Minimum Requirements: House Tr filer Tank Cap. 800 Sq. ft. line 1+00
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of final approval Signed:
Sanitarian
.i hereby certify that the above septic tank has been installed according to specifications.
Signed: 0
Septic Tank Contractor
Note: Make sketbh. of disposal system on back of sheet and mail to Health Center, Mocksville�
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